Inside the Swedish city that may prove the country's strategy was right all along

Sweden has defended its response to the Covid-19 global pandemic. Photo / AP

It had the same lax restrictions as the capital of Sweden: Schools remained open, residents carried on drinking in bars and cafes, and the doors of hairdressers and gyms were open throughout coronavirus.

But the Swedish coastal city of Malmo has shown a remarkably different result to Stockholm, with few fatalities and a remarkably low death rate.

Now some experts are questioning if the Malmo model proves that Sweden's controversial move to avoid a lockdown was right all along.

Sweden has faced mounting criticism over its death rate. But Skane, the region around Malmo, had by last week registered just 17 deaths per 100,000 inhabitants due to coronavirus, slightly fewer than the 19 per 100,000 seen in the capital region of Denmark across the Oresund straits, even though Denmark went into heavy lockdown for two months from mid-March.

Nearly half of Sweden's nearly 5000 deaths have so taken place in Stockholm, giving the Swedish capital a harrowing death rate of 95 per 100,000.

"It can hardly be explained by differences in strategy, because we have had the same strategy as in the rest of Sweden," argues Per Hagstam, specialist in infectious diseases in Skane, the health authority for the region surrounding Malmo. "That our death rates aren't higher is a result of the fact that transmission has not been so extensive down here."

Part of the reason for that comes down to the different dates for the two cities' spring sports holiday in late February and early March, when around one million people, a tenth of Sweden's population, travelled abroad.

People enjoy the warm evening weather in Malmo, Sweden. Photo / AP

While Stockholmers travelled to the ski resorts of Italy and Austria, London and elsewhere in the week of peak transmission between February 24 and March 1, those from Malmo took their holiday a crucial week earlier and were also less likely to take international trips.

Hagstam believes that Skane's health authority may also have been more successful than that of Stockholm at tracing and isolating the contacts of those who tested positive in late February and early March.

As a result, Stockholm saw cases flare up earlier, meaning local health authorities and care homes had less time to put in place measures to protect the elderly.

"I think that one explanation could be that we had more time to prepare than Stockholm had: they had a very rapid infection," Gisela Ost, director of elderly care in Malmo, says. "I think that time is one of the factors that meant that we didn't have so many infections."

She had time to circulate guidelines and equipment to the homes she manages around Malmo, stop visits, and to start rigorously testing care home personnel who reported the slightest symptom.

As a result, she says, only 100 of her elderly clients fell ill with the virus, with the number of infections peaking at 47 in April. About 20 of her clients have died, while she estimates that 85 per cent now recovered.

As well as differences in timing, Johan Carlson, director general of the public health agency, of Sweden, argued last week in an interview with the Dagens Nyheter newspaper on Wednesday that the huge regional differences in Sweden also reflected the way coronavirus spreads in clusters.

Sweden has defended its response to the Covid-19 global pandemic. Photo / AP

"The virus jumps to places and it's the same across Europe. In England it is London, and in Italy Lombardy, while Rome has been relatively spared," he told the newspaper.

"I has an extremely haphazard spread, superspreads which hit certain areas - not like the flu, which moves across the continent like a flood."

It was not only Skane that has been hit less hard than the region across the border, he pointed out. Varmland, the region of Sweden bordering Oslo, is less badly hit than the Norwegian side, and Norbotten, Sweden's most northerly region is less badly hit than across the border in Finland.

But neither Hagstam nor Ost are congratulating themselves yet, with Hagstam pointing out that while Skane has not had Stockholm's high number of infections and deaths, it has also not experienced the same peak and decline, instead seeing a constant low plateau. With lower levels of immunity than Stockholm, he fears, Malmö's peak could still be to come.

"We have a lot of respect for this virus and we don't think we have seen the end of the pandemic, even though we wish that we had," Ost says. "We have to keep on working with the guidelines because we can't say that it's over. We don't want to end up like Stockholm."